|
ID ALLERGY TITRATE-DRUG/BUG
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
30301412
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
ID ALLERGY TITRATE-DRUG/BUG
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
30301412
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
IDARUCIZUMAB 2.5 GM/50ML IV SOLN [130445]
|
Facility
|
OP
|
$58.87
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
00597019705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.44
|
| Rate for Payer: Aetna Government |
$29.44
|
| Rate for Payer: Brighton Health Commercial |
$35.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.85
|
| Rate for Payer: EmblemHealth Commercial |
$29.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.82
|
| Rate for Payer: Group Health Inc Commercial |
$29.44
|
| Rate for Payer: Group Health Inc Medicare |
$20.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.27
|
|
|
IDARUCIZUMAB 2.5 GM/50ML IV SOLN [130445]
|
Facility
|
IP
|
$58.87
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
00597019705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.44
|
|
|
IDARUCIZUMAB 50MG/ML 50ML INJ
|
Facility
|
OP
|
$1,928.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41656617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$675.08 |
| Max. Negotiated Rate |
$1,253.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,060.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$964.40
|
| Rate for Payer: Aetna Government |
$964.40
|
| Rate for Payer: Brighton Health Commercial |
$1,157.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$964.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,109.06
|
| Rate for Payer: Group Health Inc Commercial |
$964.40
|
| Rate for Payer: Group Health Inc Medicare |
$675.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.72
|
|
|
IDARUCIZUMAB 50MG/ML 50ML INJ
|
Facility
|
IP
|
$1,928.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41656617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.40 |
| Max. Negotiated Rate |
$964.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.40
|
|
|
IDARUCIZUMAB 50MG/ML 50ML INJ
|
Facility
|
OP
|
$1,928.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41646617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$675.08 |
| Max. Negotiated Rate |
$1,253.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,060.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$964.40
|
| Rate for Payer: Aetna Government |
$964.40
|
| Rate for Payer: Brighton Health Commercial |
$1,157.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$964.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,109.06
|
| Rate for Payer: Group Health Inc Commercial |
$964.40
|
| Rate for Payer: Group Health Inc Medicare |
$675.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.72
|
|
|
IDARUCIZUMAB 50MG/ML 50ML INJ
|
Facility
|
IP
|
$1,928.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41646617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.40 |
| Max. Negotiated Rate |
$964.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.40
|
|
|
I & D BARTHOLIN'S GLAND
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
40021726
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
I & D BARTHOLIN'S GLAND
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
30302437
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
I & D BARTHOLIN'S GLAND
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
40021726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$377.20
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$230.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$230.44
|
| Rate for Payer: Group Health Inc Medicare |
$230.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
I & D BARTHOLIN'S GLAND
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
30302437
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
I&D BARTHOLIN'S GLAND
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
30103235
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
I&D BARTHOLIN'S GLAND
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
30103235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$230.44
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$230.44
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
I&D BREAST ABSCESS
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
40014291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,312.42 |
| Max. Negotiated Rate |
$3,117.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$3,117.94
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
I&D BREAST ABSCESS
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
40014291
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
I&D COMPLEX POSTOP WOUND
|
Facility
|
IP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
30301269
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
I&D COMPLEX POSTOP WOUND
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
30301269
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,285.96
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
I&D COMPLEX WOUND INFECTION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
30305180
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
I&D COMPLEX WOUND INFECTION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30105180
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
I&D COMPLEX WOUND INFECTION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30105180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
I&D COMPLEX WOUND INFECTION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
30305180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,351.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,285.96
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
40019978
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$476.96
|
|
|
IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
40019978
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Brighton Health Commercial |
$809.25
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Cash Price |
$476.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$476.96
|
| Rate for Payer: Group Health Inc Medicare |
$476.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.42
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
I & D EXTERNAL EAR
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
40109221
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$813.63
|
|
